Primary Care ENT Flashcards
What is Benign Paroxysmal Positional Vertigo?
One of the most common causes of vertigo characterised by sudden onset dizziness exacerbated by a change in head position.
At what age does BPPV usually occur?
Average age is around 55 years old.
It doesn’t occur often in younger patients.
How long do episodes usually last in patients with BPPV?
10 to 20 seconds.
What manoeuvre can be performed to diagnose BPPV?
Dix-Hallpike manouvre - turn the patients head 45 degrees whilst they are seated and lie the patient back abruptly extending their neck over the bed around 20 degrees. A positive test is where a patient will have Nystagmus.
Do the same on the other side.
What manoeuvre will treat the BPPV?
The Epley manoeuvre
What is the management for BPPV?
Exercises at home that they will need to do everyday which is known as vestibular rehabilitation.
Eg. Brandt-Daroff exercises.
Betahistine can be prescribed but it is of limited value.
What is Menieres disease?
It is a disorder of the inner ear of unknown cause.
It is characterised by excessive pressure and progressive dilation of the end-lymphatic system.
How does Menieres present?
Vertigo
Tinitus
Sensorineural hearing loss
Sensation of aural fullness/pressure
Nystagmus
Positive Rhomberg’s test
How should you manage Menieres disease?
ENT referral for confirmation of diagnosis
Acute attacks: buccal/IM Prochlorperazine. Admission is sometimes required.
Prevention: Betahistine and vestibular rehabilitation exercises.
What are the most common causes of Otitis Externa?
Infection (Staphylococcus aureus, Pseudomonas. aeruginosa) or fungal infection
Seborrhoeic dermatitis
Contact dermatitis
How does Otitis Externa appear on Otoscopy?
Eczematous, erythematous swollen ear canal.
How would you manage Otitis Externa?
- Topical antibiotic or combined topical antibiotic with a steroid.
- Oral antibiotic if the infection appears to be spreading (eg. Flucloxacillin PO)
If the patient doesn’t respond to topical antibiotics then refer to ENT.
What is Malignant Otitis Externa?
Infection in the soft tissues of the external auditory meatus that often presents its self in immunocompromised individuals (90% are diabetics) commonly caused by Pseudomonas aeruginosa.
What can Malignant Otitis Externa progress to?
Temporal bone osteomyelitis
How does Malignant Otitis Externa present?
Otalgia
Temporal headaches
Purulent Otorrhoea
Dysphagia/hoarseness/facial nerve dysfunction
How do you diagnose Malignant Otitis Externa?
Order a CT scan
What is Otitis Media? What patients does it usually affect?
How does this appear on Otoscopy?
Infection in the middle ear. It usually affects young children 6-18 months.
Erythematous tympanic membrane that appears bulging.
Most common bacterial causes of Otitis Media?
Streptococcus. pneumoniae
Haemophilus. influenza
Moraxella. catarrhalis
When should you prescribe antibiotics in Otitis Media?
If the condition has lasted longer than 4 days or is not improving
If the patient is systemically unwell
Patient <2 years old with bilateral acute Otitis Media.
Perforation or discharge in the canal
What is suppurative Otitis Media?
This is where there is an effusion as a result of a chronic infection.
What is Otosclerosis?
This is where the Stapes fuses to the oval window and results in a progressive conductive hearing loss.
What is Cholesteatoma and how is it managed?
A non cancerous growth of the squamous epithelium that is trapped within the skull base leading to local destruction. Most common in patients 10-20 years old.
Presents with foul smelling non resolving discharge and hearing loss.
can also present with vertigo and facial nerve palsy dependent upon the extent of the invasion.
What is a complication of acute otitis media?
Mastoiditis
Meningitis (rarely)
What is Mastoiditis?
How does it present?
Inflammatory process within the mastoid bone.
It can present as an otalgia (behind the ear). Fever. Swelling and erythema around the mastoid process.
Ear discharge may present.
What is Ramsay-Hunt Syndrome?
Reactivation of the Varicella. zoster virus in the geniculate ganglion of the 7th cranial nerve.
What are the most common causes of acute sinusitis?
Streptococcus. pneumoniae
Haemophilus. influenzae
Rhinoviruses
How does acute sinusitis present?
Facial pain that is worsened on leaning forward.
Thick and purulent nasal discharge
Nasal obstruction
How do you manage acute sinusitis?
Analgesia
Intranasal decongestants/intranasal saline - limited evidence
Consider nasal corticosteroids when symptoms persist for longer than 10 days
Antibiotics are indicated in patients that are systemically unwell but are not often used.
How does allergic rhinitis present?
Sneezing
Bilateral nasal obstruction
Post-nasal drip
Clear nasal discharge
Nasal pruritus
How do you manage allergic rhinitis?
Mild to moderate: oral or intranasal antihistamines
Moderate to severe: intranasal corticosteroids
A short course of oral corticosteroids can be used for important life events
What is chronic rhinosinusitis?
Inflammatory disorder of the paranasal sinuses and linings of the nasal passages that take 12 weeks or longer.
How do you manage chronic rhinosinusitis?
Avoid allergen
Intranasal corticosteroids
Nasal irrigation with saline solution
Name some causes of tinnitus?
Otosclerosis
Drugs - eg. NSAID’s, Aspirin and Quinine
Acoustic neuroma
Presbyacusis
What topical treatment should be prescribed for uncomplicated acute otitis external?
Acetic acid 2% spray
What are the indications for a Tonsillectomy
More than 5 episodes in one year
The symptoms are disabling and prevent normal functioning
Sore throats are due to tonsillitis
If the patient suffers with febrile seizures resultedly
If the patient suffers with dysphagia, stridor and sleep apnoea
